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SCI
| Question | Answer |
|---|---|
| What is the term for the # of ppl with an injury at this time, regardless of when the injury occurred? | Prevalence |
| What is the term for the number of new cases per year? | incidence |
| What race, gender, and age groups do most SCIs occur in? | Male, Caucasian, 16-30 yrs old |
| What are the two highest occurring etiologies of traumatic SCI? | MVA and falls |
| List other etiologies of SCI | MS, Tumor, spinal column degeneration, spinal CVA, infection (meningitis, transverse myelitis) |
| Are incomplete injuries or complete injuries more common?Is quadriplegia or paraplegia more common? | Incomplete, quadriplegia |
| Why do C4 injuries or above result in ventilator dependency? | The innervation of the diaphragm (C3-5) is impaired, which is the primary muscle of respiration |
| What indicates that an injury is complete? | absent sensory and motor function in the lowest sacral segments (S4-S5) |
| What indicates that in injury is incomplete? | sparing of sensory or motor function in the lowest sacral segments |
| Name the mechanism of injury with SCI (3-with subsets) | indirect forces: hyperext, hyperflex, compression, flexion/rotation; shearing: horizontal force (seatbelt injury); distraction: traction force (least common) |
| Which region of the spinal cord are injuries the least common? | thoracic |
| What is the name of the term for the most common area of SCI? | transition zones (i.e. CT junction) |
| What do you call the initial mechanical damage to the spinal cord? | primary injury |
| What do you call the progressive cellular injury occurring after initial injury (edema, ischemia, etc)? | secondary injury |
| What are the two most important things for first responders when suspecting a SCI? | stabilize the spine if there is any suspicion of SCI, maintain open airway |
| What items are part of the acute mgmt of a SCI? | imaging, pharmacological interventions, fracture stabilization, surgery |
| When are CT and MRIs clinically indicated? | When spinal injury is confirmed by x-ray first, because of it's speed and accessibility this is the first type of imaging completed |
| What is the only pharmacological therapy shown to reduce the extent of damage in SCI? When must it be administered to be effective? What is the mechanism of action? | Methylprednisone (steroid); within 8hrs of injury and cont'd for only 24-48 hours; it is an anti-inflammatory and immunosuppressant |
| What are two methods of fracture stabilization? | orthoses or surgical fixation (decompression and fusion) |
| What do you call the time period with the absence of all neurologic ativity (motor, sensory, autonomic, reflex) below the level of the injury which occurs immediately after injury and resolves over a period of days to weeks? | spinal shock |
| What is a sign of resolving spinal shock? | return of sacral reflexes; this is also an indicator of an incomplete injury (i.e. bulbocavernous and anal wink reflexes) |
| What is the incidence of DVT in the first 12 weeks following SCI? And when do a majority of those occur? | 49-100%; 1st 2 weeks |
| What indicates the subacute phase of SCI has begun? | resolution of edema and inflammation; emergence of UMN signs (hypertonicity, pathologic reflexes, etc); rapid neurologic and functional recovery are possible |
| What are some of the concerns during the subacute phase of SCI? | pressure ulcers, heterotopic ossification, urinary tract infections, osteoporosis, and autonomic dysreflexia |
| Why are improvements slower in the chronic phase of SCI? | There is a lack of spontaneous recovery as in the subacute phase |
| What are some problems that may arise in the chronic phase of SCI? | shoulder pain (resulting from repetitive use propelling w/c and performing tfs); abnormal postures (stemming from weakness and can impair function); osteoporosis (secondary to weakness and lack of WB) |
| What is the term for lack of all voluntary motor control below the level of injury consistent with affected spinal levels and descending tracts? | paralysis |
| What is the term for spotty loss of strength, weakening of muscles where some strength remains or a loss of strength in some but not all muscles? | paresis |
| The following are signs of UMN or LMN injury? | Spasticity, no disuse atrophy, increased DTRs, pathological reflexes present, absent fasciculation and fibrillation |
| The following are signs of UMN or LMN injury? | flaccid paralysis, severe atrophy, absent DTRs, absent pathological reflexes, fasciculation and fibrillation may be present |
| Name the ascending tracts | dorsal column medial lemniscus (fasciculus cuneatus, fasciculus gracilis); posterior spinocerebellar; anterior spinocerebellar, spinothalamic (anterolateral) |
| Name the descending tracts | lateral corticopsinal, rubrospinal, lateral reticulospinal, medial reticulospinal, vestibulospinal, tectospinal, medial corticospinal |
| What do you call excessive sympathetic nervous system activity triggered by affarent stimuli (noxious or non-noxious) below the level of the injury? | autonomic dysreflexia |
| Name some triggers of autonomic dysreflexia | UTI, bowel impaction, catheter blockage, skin irritation |
| Rapid increase in BP, reduced HR, piloerection/goosebumps, diaphoresis, and flushed skin above the level of the injury are signs of what? | autonomic dysreflexia |
| Name some of the symptoms associated with autonomic dysreflexia and how do you manage it? | pounding headache, chills, anxiety, nausea; sit the person up and identify the irritant |
| Why do cardiac problems occur with SCI? | There is a lack of supraspinal control below the injury level, common with cervical injuries, hypotension and bradycardia; The vagus nerve provides much of the regulation of the heart. |
| What are signs and symptoms of orthostatic hypotension? and what is the intervention? | decrease in SBP >20 mmHg; decrease in DBP >10mmHg when transitioning to upright; pallor, diaphoresis, LOC, dizziness, light-headedness, faintness, nausea; lie the person down with LEs elevated |
| Why are respiratory impairments common with SCI? | Phrenic nerves (C3-5) innervate the diaphragm, injuries above C4 cannot breathe independently; abdominal muscles/intercostals weak can alter breathing pattern and result in inability to cough/clear secretions |
| What are some interventions for those with respiratory compromise and SCI? | assisted cough and postural drainage techniques |
| Name the parasympathetic, sympathetic, and somatic bladder innervations. | para: pelvic nn. (S2-4 nerve roots); symp: hypogastric nerve (T11-L2 nerve roots); somatic: pudendal nerve (S1-4 nerve roots) |
| When the injury is above the conus medullaris, the S2-S4 reflex arc is intact, the bladder empties reflexively (frequent and rapid voiding); what is it called | reflexive or spastic bladder |
| When the injury is to the conus medullaris or cauda equina, S2-S4 reflex arc is disrupted, resulting in overflow incontinence if artificial drainage does not occur; what is it called? | areflexive/flaccid bladder |
| Name the parasympathetic, sympathetic, and somatic bowel innervations. | Para: pelvic nerve (S2-S4 nerve roots-vagus nerve); symp: hypogastric nerve (T11-L2 nerve roots-superior and inferior mesenteric nerves arising from T9-T12 nerve roots); somatic: pudendal nerve (S1-S4 nerve roots) |
| When the injury is above the conus medullaris and the S2-S4 reflex arc is intact, reflexive defecation occurs; what is this called? | reflexive/spastic bowel |
| When the injury is to the conus medullaris or cauda equina, S2-S4 reflex arc is disrupted, intrinsic (myenteric plexus) reflex is intact but peristaltic activity is too weak, and bowel impaction is possible; what is this called? | areflexive or flaccid bowel |
| Describe temperature regulation impairment with SCI. | Elevation or decrease in body temperature without the presence of an infection can result from environmental temperature change; may be unable to sweat properly below the level of the injury |
| What position is the ASIA AIS scored in? | supine |
| How many muscles are tested bilaterally? ASIA AIS; And how are they scored? | 10 myotomes (C5-T1) and (L2-S1); Scored 0-5 (no +/-) |
| How many points are tested for sensory function ASIA AIS? How are they scored? | 28 points-light touch and pinprick (C2-S5 dermatomes); Scored 0-2 (0=absent; 1=impaired; 2=normal) |
| List the myotomes tested | C5-S1 |
| What is the UE motor score? What is the max? | the sum of MMT of UEs bilaterally; 25 per UE/50 total |
| What is the LE motor score? What is the max? | the sum of MMT of LEs bilaterally; 25 per LE/50 total |
| What is the light touch total? What is the max? | the sum of the light touch testing of UEs and LEs bilaterally; 56 per side of the body/112 total |
| what is the pinprick total? what is the max? | sum of pinprick testing of UEs and LEs bilaterally; 56 per side of the body/112 total |
| How do you determine the sensory level? | It is the most caudal , intact dermatome for both pinprick and light touch sensation (score of 2) |
| How do you determine the motor level? | It is the lowest key muscle function that has a grade of at least 3, providing the key muscle functions represented by segments above that level are intact (graded as 5); in regions where there is no myotome to test, the motor level=sensory level |
| So how do you determine overall neurologic level? | The most caudal segment of the cord with intact sensation and antigravity muscle function strength; the most cephalad of the sensory AND motor levels |
| This type of injury may contain a zone of partial preservation, absent voluntary anal contraction, all S4-5 sensory scores=0, and deep anal pressure is absent. | complete injury; ASIA AIS A |
| This type of injury may have some sacral sensory or motor function remaining. | Incomplete injury |
| Sensory but not motor fx is preserved below the neurological level and includes the sacral segments S4-5 (lt touch or pinprick at S4-5 or deep anal pressure) AND no motor fx is preserved more than 3 levels below the motor level on either side of the body | ASIA AIS B; sensory incomplete |
| Motor fx is preserved below the neurological level, and more than half of key muscle fxs below the neurological level of injury have a muscle grade <3 | Motor incomplete; ASIA AIS C |
| Motor fx is preserved below the neurological level, and at least 1/2 of key muscle fxs below the neurological level of injury have a muscle grade greater than or =to 3. | motor incomplete; ASIA AIS D |
| If sensation and motor function are normal in all segments, and the patient had prior deficits. | Normal; ASIA AIS E |
| The lowest dermatome or myotome on each side with some preservation; only determined for complete AIS A injuries | Zone of Partial Preservation |
Created by:
metz
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